AB0885 HIGH RESOLUTION IMPEDANCE MANOMETRY IN DERMATOMYOSITIS ALLOWS THE CHARACTERIZATION OF ESOPHAGEAL DYSMOTILITY AND THE PROFILING OF DIFFERENT CLINICAL AND SEROLOGICAL SUBSETS
Authors: C. Rizzo, L. La Barbera, F. Camarda, D. Donzella, G. Barletta, S. Bonventre, G. Guggino
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Esophageal involvement is common in dermatomyositis (DM), occurring in up to 54% of patients [1]. It can lead to severe complications, such as malnutrition and aspiration pneumonia. Therefore, esophageal assessment is of foremost importance to drive patients management. Recently, high-resolution impedance manometry (HRiM) has emerged as a promising technique to assess esophageal motility and has already been tested in systemic sclerosis [2]. <h3>Objectives</h3> To evaluate esophageal motility by HRiM in DM and correlate the alterations to clinical and serological disease domains. <h3>Methods</h3> We analyzed HRiM findings in 15 consecutive DM patients enrolled in our clinic between December 2021 and December 2022. All patients received a rheumatological assessment, including screening questions for dysphagia, and underwent HRiM. All HRiM parameters (Integrated relaxation pressure (IRP), percentage of LES relaxation, distal contractile integral (DCI), distal latency (DL), upper esophageal sphincter (UES) pressure) were studied, coupled with impedance findings (esophageal clearing and bolus transit time). The report followed the Chicago Classification v.4.0 for esophageal motility disorders. The associations between HRiM findings and DM features were evaluated. <h3>Results</h3> DM patients were divided according to their serological status: 5 Mi2 (33%), 6 MDA5 (40%), 2 Ku (13%), 1 NXP2 (6.6%), 6 Ro52 (40%). Asymptomatic patients presenting at least one HRiM alterations were 4 (26.7%). Among HRiM parameters, 83.3% MDA5 patients and 50% Ro52 patients showed high UES pressure (Figure 1), in contrast to the other serological groups. Among impedance findings, incomplete bolus clearance was detected in MDA5 (67%) and in Ro52 patients (50%). Notably, the only NXP2 patient showed 100% of incomplete bolus clearance. Considering the Chicago classification v.4.0, only 16.7% of MDA5 patients had a normal esophageal motility, the rest presenting absent contractility (33.3%) and ineffective esophageal motility (IEM) (50%). Distal esophageal spasm was evidenced only in Mi2 patients (40%). All patients with concomitant manometric and impedance alterations were MDA5 positive. DM patients with high UES, IEM or impedance abnormalities presented higher rate of lung involvement and active Raynaud's phenomenon (Table 1). No relation with ongoing treatment emerged. <h3>Conclusion</h3> We describe for the first time HRiM findings in DM. Anti-MDA5 patients appear to have a more severe esophageal involvement, even in absence of reported dysphagia, followed by anti-Ro52 patients. Interestingly, the same subsets show higher prevalence of lung involvement and Raynaud's phenomenon, suggesting a possible pathogenetic link between esophageal, lung and microvascular disease. Asymptomatic patients may present occult esophageal motility disorders detected by HRiM. Further validation of our findings are required to definitely include HRiM in the workup of DM patients as a diagnostic, prognostic and monitoring tool. <h3>References</h3> [1]Ebert EC. Review article: the gastrointestinal complications of myositis. Alimentary Pharmacology &amp; Therapeutics. 2010 [2]Vettori S et al. Esophageal high-resolution impedance manometry alterations in asymptomatic patients with systemic sclerosis: prevalence, associations with disease features, and prognostic value. Clin Rheumatol. 2018 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Chiara Rizzo: None declared, Lidia La Barbera: None declared, FEDERICA CAMARDA: None declared, DENISE DONZELLA: None declared, Gabriele Barletta: None declared, Sebastiano Bonventre: None declared, Giuliana Guggino Speakers bureau: Pfizer, Novartis, Celgene, Abbvie, Roche, Lilly, Janssen, UCB.